Study: Children with mental health concerns staying in EDs longer

Children being treated in the emergency department (ED) for mental health concerns are staying longer than they did a decade ago, highlighting the need for better access to care.

Researchers analyzed data from the National Hospital Ambulatory Medical Care Survey on children ages 6-17 years and reported their findings in “Prolonged Emergency Department Length of Stay for U.S. Pediatric Mental Health Visits (2005-2015),” (Nash KA, et al. Pediatrics. April 5, 2021, https://doi.org/10.1542/peds.2020-030692).

The team found about 25% of the mental health ED visits in 2015 lasted more than six hours, up from 16% in 2005. About 13% of the mental health ED visits in 2015 lasted more than 12 hours, up from 5% a decade prior. Length of stay for non-mental health visits were stable during this time.

“Mental health care for children is expensive and suboptimal reimbursement limits incentives to expand services,” authors wrote. “There continues to be a dearth of child psychiatrists and community supports. EDs struggle to safely discharge children who present in crisis to appropriate care settings in light of limited services and poor coverage, which in turn leads to prolonged ED LOS (length of stay).”

Racism, language barriers and immigration status may compound these issues for Hispanic children, who were almost three times as likely as White children to be in the ED for more than 12 hours.

Authors called for state and federal policy changes to improve coverage of mental health services and increase the number of specialists. In addition, they recommended EDs ensure around-the-clock access to trained pediatric mental health providers, provide additional training to ED staff and consider having a designated space in the ED for children with mental health concerns.

Authors of a related commentary noted the COVID-19 pandemic has taken an additional toll on mental health, and Black and Hispanic families may suffer disproportionately. They suggested additional funding to increase the availability of mental health crisis services.

“Strengthening pediatric community mental health resources, including crisis response services, would facilitate access to high quality mental healthcare outside of the ED,” they wrote. “In addition, engaging members of marginalized communities in healthcare services planning will ensure access to mental health care for all children.”